"I would be dead without Middlegate" she told me simply, "I had nowhere to go psychologically, no future. I needed to be shown that my life would be better without drugs. That is what the therapist here did. I had never experienced happiness without drugs before." A seventeen year old former resident of Middlegate I interviewed last year.

It's somewhat ironic that only since we had a national adolescent treatment policy did Middlegate, the country's only teen residential rehab, begin to struggle. Last week it gave up the ghost and closed.

Up until 2004 it was full and had waiting lists. But then (pre 2002) its funding for drug addicted young people came from local Social Services. With the advent of New Labour's barrage of Primary Care Trusts, Children's Services, Adolescent Drug Services and Youth Offending Teams this all changed. The funding, and the will to find it, evaporated.

Only the most concerned of workers faced the challenge in recent years, however desperate the child's drug problem.  You have only to hear how complex it is to coordinate funds - from three separate sources, the  PCT, local Children's Services (for the education component) and the DAT - to understand why. The National Treatment Agency, architects of  our new adolescent 'services', have no interest in resolving the funding trilemma, let alone in developing more such dedicated residential services.  They have steadfastly refused to allocate any of the annual £25 million budget set aside for adolescent treatment.  So last week, after a final vain appeal, with too many empty beds for too long, Middlegate found itself closing its doors.

Now, there is nowhere that children and young people can be detoxed under medical supervision that is not part of a mental health facility or another adult service.  Middlegate was unique. It was a model for safe and specialist care in a domestic environment; where adolescents became drug free and went on to solve their underlying emotional problems, regain their health - mental and physical - and restart their education.

The 'Save Middlegate Campaign' set up by those of us who know of its work failed to raise the £100,000 needed to keep them open for another 12 weeks.  This was hardly surprising; for no philanthropist was likely risk his capital to stave off the current crisis without a guarantee of a future referral cash flow. Yet last week when the staff were issued their redundancy notices and the liquidators called in it was not for want of demand or for need or for proof of successful outcomes.

If other countries recognise the need for residential respite for adolescents why not the UK we asked?  Sweden and Holland are both fast expanding their provision. In Stockholm the Maria Ungdom Centre is open 24/7 all year around including Christmas day. A child can be brought in without referral anytime of night or day by parent or police or social workers and see trained nursing and addiction staff immediately.  All are fully assessed. Some stay three nights, some three weeks, some three months. Two thousand passed through this one centre last year.  Holland is currently doubling its 600 bed adolescent rehab capacity. But here Dawn Primarolo, Minister for Substance Misuse, has remained blind in her insistence that such children's needs are already catered for

"For those young people who do need treatment, there are a record number of places available" Primarolo wrote.  Only numbers count for the NTA's publicity machine which claims to be 'getting to grips with substance misuse' by meeting  record treatment targets of  some 25,000 children in treatment 'in the community'.  It is these targets that Middlegate has fallen foul of; a philosophy where numbers count but not individuals and that denies the obvious - that young people struggle to get off drugs in their own neighbourhoods. Up against state orthodoxy "Middlegate has been fighting a battle it can't win", as its Chairman Chris Robertson said, "and workers cannot get by the 'one size fits all' syndrome to find funds".

Middlegate's medical director Dr David Bee has said that "Community care always fails to reach the more complex and chaotic young people who sadly represent the real victims of Middlegate's closure. "

Certainly for the teenager at Middlegate that I interviewed it had been a wasteful and costly disaster. Only after years of drug taking, living on the streets, in and out of care and failed community 'treatment', did this girl get referred to Middlegate, become drugs free and get on track with her education.    A cannabis smoking runaway she was already seeking out stronger drugs by 14. She was introduced to heroin and crack and then into to prostitution to pay for it all before she was 16. Her first social worker had the preconceived idea of 'rebuilding' her family. Her second put her into emergency foster care from which - with her drug taking unabated - she was kicked out.

Next she was put in 'supported lodging' with an alcoholic 'mother'. She ran away. Eventually she was moved into a staffed house and given drug treatment in the community where she 'failed' five community detoxes.  She said that half the kids on the programme were only interested in getting more methadone to sell it and the drugs workers used medication as a bargaining tool.  Even under 16 they could get 40mls a day.  For her part she said she was too scared to give up her drug use. Her drugs 'friends' always sought her out. Finally and luckily for her a student social worker fought the fight to get her into Middlegate, for she had 'never come across a community drugs worker who had the skills to help as I have found here". Next summer she sits 4 academic A levels, having already passed her AS levels.

The problem as Middlegate's senior therapist, Martin Williams sees it, is that the children use community services to support their lifestyle, not to change it.  These services often cannot address the fact that drug use is a symptom of the children's circumstances and of the adults in their lives. Simply trying to 'bring down' their illicit use cannot solve the problem he argues - all it does is to maintain everything else that is wrong.

Dr David Bee agrees: "Often treatment in the community is about a maintenance prescription for a young person and this fails to deal with the issues that are underlying their drug and alcohol misuse.... it always fails to reach the more complex and chaotic young persons who sadly represent the real victims of Middlegate's closure".

His message is categorical: "The loss of such an effective model and therapeutic team leaves a huge gap in the national provision for an integrated, safe and controlled detoxification pathway for young people. Adult facilities cannot hope to become an appropriate substitute for Middlegate's expertise -  they lack the flexibility to embrace and adapt to the more challenging and individual needs of a younger age group".

The whole team are understandably furious and upset with Dawn Primarolo's and the NTA's disingenuous and Alice in Wonderland denial of Middlegate's treatment programme; that it  does not address those 'wider needs' - the  complex issues "of which substance misuse is just one" - of the minority of children assessed as requiring  residential treatment.

As if Middlegate's blueprint of social care, therapy and education in a safe setting, has not proved that it does exactly this.

Correspondence with David Burrowes MP, 6.7.09

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